What causes tinnitus? The Oto Health Guide 2020

Fatema Dawoodbhoy
Intern at Oto Health | 5th Year Medical Student
October 7, 2020

Ringing or buzzing in the ears is incredibly common and affects millions of people all over the world. But what causes tinnitus? How does it start? Is it preventable? We're going to shed some light on the most commonly asked questions about the condition.

Overview

Did you know 1 in 10 people in the UK have tinnitus? That’s 10% of the population battling this silent condition. It can be seriously debilitating, not only affecting hearing but also having adverse consequences on sleep, stress and mental health. I have seen the effects tinnitus has on someone dear to me - my mother. She was diagnosed with tinnitus 20 years ago and I have witnessed first hand the effects it has had on her personal, professional and social life. But this has not stopped her from achieving what she wants in life, from public speaking to chairing the PTA, all while raising 4 children.  

I’m sure for those of you reading that don’t have tinnitus, like me you will know someone with it. It is important to clarify that it is not a disease but a symptom of an underlying cause. Tinnitus is a term to describe hearing sounds from inside the body rather than externally. Essentially, you can hear a sound, or sounds, when that sound does not exist in the world outside you. Tinnitus is normally a symptom indicating an issue in the auditory system: the ear, auditory nerve that connects the inner ear to the brain and other parts of the brain that process sound.

A common phrase people with tinnitus might use to describe tinnitus is a “ringing in the ears” but the sounds heard also include buzzing, humming, grinding, hissing and whistling. It can be intermittent, permanent, or pulsating and might be heard in one or both ears and be present all or only sometimes. Tinnitus comes in many shapes and forms, varying uniquely with each person.

Common Causes of Tinnitus

I’m going to start by tackling one of the biggest questions regarding tinnitus - what causes it?

Sadly there is no permanent cure. This is largely because there are many different potential causes, and like most medical problems we do not fully understand the underlying reasons why some people experience tinnitus. However, there are multiple potential causes of tinnitus which we will discuss further below.

Ear wax and ear problems can cause tinnitus
Ear wax and inner ear problems can often cause tinnitus.

Ear wax

Something as simple as a piece of earwax causing an occlusion to the ear canal can cause tinnitus. Earwax is something we regard as unpleasant and sticky but in reality, it has a lot of protective features for our ear. It coats our ear canal, trapping dirt and impeding the growth of bacteria inside the ear. However, a good balance is always needed. When the earwax accumulates and hardens, it becomes difficult to wash away naturally and hence can result in hearing loss or eardrum irritation leading to tinnitus.

Ear bone changes

Otosclerosis is a condition which results in the abnormal growth of bones inside the ear. Inside the ear, there are 3 tiny bones present which vibrate when sound waves enter. They are responsible for transmitting sound waves to the inner each where the sound waves are converted into signals later sent to the brain. When otosclerosis is present, one of the three bones (the stapes) fuse its surrounding bones and eventually becomes rigid and immoveable. As a result, this means that sound waves are not efficiently transmitted to the inner ear. This cause of tinnitus tends to run in families.

Loud noises

Approximately 70% of tinnitus is caused by loud noises. This is a hard one to avoid. Loud noises are all around us, from fire alarms to concerts. We can’t avoid them all, but we can try to protect against them. Any loud sudden noise, from any source, can shock our auditory canal and damage it resulting in tinnitus. If the loud noise exposure was for a short period of time, the tinnitus tends to resolve and go away but short or long-term exposure can also cause permanent damage leading to lifelong tinnitus.

Tips on protecting against loud noises:

  • Plan ahead - if you know you’re going to a loud event (eg. concerts or sports games), bring some earbuds
  • Music - I’m sure we’re all guilty of turning up the music too loud to drown out the background noises, but this can be detrimental to your hearing. Try investing in noise-cancelling headphones
  • Hearing test - if you are worried about your hearing health, it can be a good idea to get your hearing tested

Age-related

People grow old, even if we don’t like it. Old age is linked to many conditions, such as worsening eyesight and hearing. People around the age of 60 tend to gradually start experiencing a worsening in their hearing. This hearing loss can also cause tinnitus. The medical term for this specific type of hearing loss is presbycusis.

So far, we have covered the most common causes of tinnitus. But are there most causes of tinnitus? The causes of tinnitus are endless from medication conditions, blood vessel disorders and medication-induced tinnitus. I will not cover these other rare causes.

What causes tinnitus: Often age related hearing loss is a common cause
Age related hearing loss is a really common cause of tinnitus.

Medical problems that cause tinnitus

There are known medications that have been linked to the cause or worsening of tinnitus. It is generally thought that in higher doses, the higher the risk of tinnitus. But when the medications are stopped, it tends to subside and usually will stop. The medications include

  • Antibiotics: polymyxin B, erythromycin, vancomycin and neomycin
  • Cancer medications: methotrexate and cisplatin
  • Diuretics (water medications): bumetanide, ethacrynic acid or furosemide
  • Quinine medications used in the treatment of malaria or other conditions
  • Certain antidepressants
  • Uncommonly high doses of aspirin.
There are medications that cause tinnitus that are prescribed by your doctor.
Many medications prescribed by your doctor can cause tinnitus - remember to ask if you start developing symptoms!


I know that was a lot of medical jargon and you have probably have never heard of these medications. If you happen to be taking any,, your doctor will have probably advised you to look out for any symptoms . If you do think your tinnitus is linked to one of these medications, make an appointment with your GP to discuss it further.

Meniere’s disease

Meniere’s disease is a condition affecting the inner ear resulting in symptoms like pressure deep inside the ear, hearing loss, vertigo and tinnitus. Meniere’s disease is thought to be linked to the inappropriate amount of fluid found in the inner ear, but again like most medical problems the exact cause is uncertain. For Meniere’s disease, tinnitus is considered an early indicator of this disease and aids in the diagnosis of the disease.  

Acoustic neuroma

Acoustic neuroma - it is a scary sounding word. To make it more confusing, medics sometimes call it  vestibular schwannoma. This is the development of a non-cancerous benign tumour on one of the cranial nerves that runs from your brain to the inner ear. This cranial nerve is responsible for balance and hearing. The tumour places pressure on the nerve and thus affects hearing and thus tinnitus. This cause of tinnitus only results in tinnitus in one ear.

Causes of tinnitus can include head and neck injuries.
Head and neck injuries can cause tinnitus in many cases.

Injuries - head and neck

Specifically head and neck injuries can result in tinnitus. It is difficult to prevent any injury to the head or neck as no one deliberately tries to get injured. Sometimes, life just deals us a bad hand. However, some people are at an increased risk of such injuries depending on their profession. Sports professionals such as football or rugby players or manual workers like builders might injure their head and neck at some point in their career.

Injuries, especially to the head and neck may lead to a life of tinnitus. These injuries can also injure the inner ear and any injury to the inner ear can affect one or more of the anatomy linked to hearing. Depending on the extent of the injury to the inner ear, it will correlate to the severity of the tinnitus. Usually this cause only results in tinnitus in one ear.

Muscle spasms

We have probably at some point in our lives experienced muscle spasms or cramps. The involuntary movements where the muscles contract but cannot relax. Sometimes we feel as though our muscles are twitching and after some time it goes back to normal. We also have muscles in our inner ear and the exact same can happen to those muscles. The muscles tense up and spasms resulting in tinnitus and also hearing loss. The reasons behind this is again unknown but there are some neurological conditions such as multiple sclerosis where this happens more commonly.

Eustachian tube dysfunction

The eustachian tube is a small pipe that connects the middle ear to the upper part of the throat. This tube is in charge of regulating the pressure within the middle ear, equalising the pressure inside and outside the ear. When a person has Eustachian tube dysfunction, this tube remains expanded all the time resulting in full sensation in the ear. One of the symptoms of the condition can be tinnitus and problems with hearing.

Blood vessel disorders

These blood vessel-related causes of tinnitus are much rarer . They usually result in a specific type of tinnitus called pulsatile tinnitus. Pulsatile tinnitus occurs as a  result of blood circulating in or near your ears. Instead of hearing a steady ringing or buzzing, you would tend to hear a rhythmic sound that follows the same rate of the heart.

Some common blood vessel disorders are:

  • Atherosclerosis
  • Atherosclerosis is a condition with an increased build-up of cholesterol in the blood vessels. There are blood vessels close to your middle and inner ear. Atherosclerosis builds up in these blood vessels and tends to lose their elasticity. This causes the blood to flow through these vessels at an increased force which increases the ears sensitivity to the beats at which the heart pumps blood. This type of tinnitus is usually present in both years.
  • High blood pressure
  • High blood pressure increases the force at which blood is being pumped in the blood vessels in the ear. This rise in force again makes it easier for the ear to detect the beats of the heart.
  • Malformation of capillaries
  • There is a specific condition called arteriovenous malformation (AVM) where the blood vessels are abnormally formed and the arteries and veins become entangled. This results in pulsatile tinnitus in one ear.

I know this blog has been packed with information about the vast causes of tinnitus but I hope this blog has answered any questions you may have about what causes tinnitus.

Struggling with your tinnitus?

At Oto Health, we aim to revolutionise tinnitus treatment by bringing therapies directly to your smartphone using a simple mobile app called Oto. Oto is your digital tinnitus therapist, first helping you to better understand how your tinnitus affects you, and then guiding you through the therapy journey. Oto has been created by a dedicated team of doctors, scientists and tinnitus experts. We have decades of experience in managing tinnitus.

Now you know what causes your tinnitus, download Oto to get instant access to therapy
Download Oto and get instant access to tinnitus therapy on your smartphone.

How does Oto work?

Oto brings together all the known effective therapies in tinnitus management into a progressive programme of cognitive behavioural therapy (CBT), targeted mindfulness, relaxation therapy and education. Work through Oto’s therapy modules whilst filling in a hearing health log to see how your tinnitus improves over time. Oto harnesses the power of artificial intelligence to give you in-depth insight into your tinnitus and hearing health in general, with quick and simple tracking.

Oto allows you to access tinnitus therapy from the comfort of your own home, for a fraction of the cost of private therapy. No more long waiting lists, no more driving to appointments.

Want to try Oto?

We’re currently testing the pre-release version of Oto. If you’d like to test this for free, please use the download link below.

NB. To download Oto on iOS, you’ll need to first download Apple’s TestFlight app. This will allow you to join our testing programme.

References

1.NHS Choices. 5 ways to prevent hearing loss - Healthy body. [Online] NHS. Available from: https://www.nhs.uk/live-well/healthy-body/top-10-tips-to-help-protect-your-hearing/

2.American Tinnitus Association. Causes. [Online] www.ata.org. Available from: https://www.ata.org/understanding-facts/causes

3.American Tinnitus Association. Understanding the Facts. [Online] www.ata.org. Available from: https://www.ata.org/understanding-facts

4.NHS Choices. Ménière’s disease. [Online] NHS. Available from: https://www.nhs.uk/conditions/menieres-disease/

5.NIDCD. Tinnitus. [Online] NIDCD. Available from: https://www.nidcd.nih.gov/health/tinnitus

6. NHS Inform. Tinnitus symptoms and treatments. [Online] www.nhsinform.scot. Available from: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/tinnitus

7.Mayo Clinic. Tinnitus - Symptoms and causes. [Online] Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156#:~:text=Earwax%20protects%20your%20ear%20canal [Accessed: 15th September 2020]

8.NHS. Otosclerosis. [Online] nhs.uk. Available from: https://www.nhs.uk/conditions/otosclerosis/




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